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Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial

CONTEXT: Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain. AIMS: To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia. SETTINGS AND DESIGN: This prospective randomized control trial was con...

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Autores principales: Sivachalam, Swetha N., Puthenveettil, Nitu, Rajan, Sunil, Paul, Jerry, Kumar, Lakshmi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545939/
https://www.ncbi.nlm.nih.gov/pubmed/31198255
http://dx.doi.org/10.4103/aer.AER_38_19
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author Sivachalam, Swetha N.
Puthenveettil, Nitu
Rajan, Sunil
Paul, Jerry
Kumar, Lakshmi
author_facet Sivachalam, Swetha N.
Puthenveettil, Nitu
Rajan, Sunil
Paul, Jerry
Kumar, Lakshmi
author_sort Sivachalam, Swetha N.
collection PubMed
description CONTEXT: Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain. AIMS: To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia. SETTINGS AND DESIGN: This prospective randomized control trial was conducted in a tertiary care institution. SUBJECTS AND METHODS: Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S(1) level, and sedation score were noted. STATISTICAL ANALYSIS USED: To test the statistical significance of duration of sensory blockade, Mann–Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test. RESULTS: The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S(1) dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039). CONCLUSION: Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability.
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spelling pubmed-65459392019-06-13 Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial Sivachalam, Swetha N. Puthenveettil, Nitu Rajan, Sunil Paul, Jerry Kumar, Lakshmi Anesth Essays Res Original Article CONTEXT: Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain. AIMS: To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia. SETTINGS AND DESIGN: This prospective randomized control trial was conducted in a tertiary care institution. SUBJECTS AND METHODS: Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S(1) level, and sedation score were noted. STATISTICAL ANALYSIS USED: To test the statistical significance of duration of sensory blockade, Mann–Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test. RESULTS: The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S(1) dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039). CONCLUSION: Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6545939/ /pubmed/31198255 http://dx.doi.org/10.4103/aer.AER_38_19 Text en Copyright: © 2019 Anesthesia: Essays and Researches http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sivachalam, Swetha N.
Puthenveettil, Nitu
Rajan, Sunil
Paul, Jerry
Kumar, Lakshmi
Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title_full Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title_fullStr Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title_full_unstemmed Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title_short Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial
title_sort comparison of prolongation of spinal anesthesia produced by intravenous dexmedetomidine and midazolam: a randomized control trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545939/
https://www.ncbi.nlm.nih.gov/pubmed/31198255
http://dx.doi.org/10.4103/aer.AER_38_19
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